I’m Dr Jonathan Salo, a Cancer Surgeon at the Levine Cancer Institute.

.font60[If you’re seeing this video, it’s likely because you have a recent diagnosis of esophageal cancer.]

This video is designed to help you choose a surgeon and hospital for your esophagectomy surgery.

Plan

Understanding Outcomes

We’re going to start by talking about outcomes after surgery and how statistis can help you make a decision about your surgery. Let’s talk Baseball for a minute.

Baseball

.pull-left[ If you want to evaluate how a team is doing, you look at the scoreboard ]

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.pull-left[If you want to evaluate a baseball player, you look at their batting average ]

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.pull-left[Micky Mantle is regarded as one of baseball’s greatest players, and this baseball card from 1952 is one of the most valuable in history.]

.pull-right[]

.pull-left[If you look at the back of his card, you’ll find lots of statistics, including his … batting average]

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The batting average and other numbers allows fans to compare players. A player with a high batting average doesn’t hit a home run every time at bat, but a player with a high batting average is certainly going to help win more games than a player with a low batting average. The batting average won’t absolutely predict what will happen with every time a player goes to bat, but it shows an average over the season or over a career.

When you choose a surgeon or a hospital for your esophagectomy, you want to find the best chance of success.

Unfortunately, there aren’t baseball cards for hospitals and surgeons, and finding the statistics for a hospital or surgeon can be a challenge, but it’s still important to help you make a decision.

Hospital Volume

Practice makes perfect in many things in life, and esophageal surgery is no exception.

Hospitals where an esophagectomy is performed more frequently in general have better outcomes than hospitals where the operation is only occasionally done.

This chart shows the relationship between hospital volume and the risk of death after esophagectomy.

The risk of death after esophagectomy is about twice as high in hospitals which perform less than 5 esophagectomy operations per year.

Finding a Hospital

The easiest way to find out whether a particular hospital is high volume or low volume is to ask your surgeon.

Another method is to do some research on the internet. The Leapfrog Group is a non-profit organization that collects and published safety in healthcare. Their website ranks hospitals for safety and can help you find a high-volume hospital.

Leapfrog Group Website

You can find a link to their website in the description: HospitalSafetyGrade.org

You can search on a hospital. Once there, you can click “View this hospital’s leapfrog Hospital Survey Results”

Of course there are low-volume hospital that have good outcomes, but starting with a high-volume hospital is a place to start.

Choosing a Surgeon

The surgeon is another key factor in the outcome of an operation. The Leapfrog recommends a minimum of seven operations per year for surgeons undertaking esophagectomy.

Your Surgeon’s Outcomes

Knowing your hospital’s outcomes is important, but knowing your surgeon’s outcomes is probably more important. Your surgeon should be able to tell you what their statistics are for outcomes like anastomotic leak, pneumonia, and death after surgery.

If you surgeon doesn’t know their personal statistics, you may want to look for a second opinion. After all, if you met a professional baseball player, you would expect that they would be familiar with their batting average.

Risk assessment

As we showed in a previous video, the patient’s overall health, particularly their muscle strength, is an important factor in predicting the risk of complications after surgery. If you haven’t done so already, I would recommend watching our video on esophageal surgery. There is a link above and there will be a link in the description.

When you meet with your surgeon, part of the consultation will be to evaluate your overall health and your personal risk of complications after surgery

Questions for Your Surgeon

  1. How many esophagectomy operations are performed each year in your hospital?
  2. How many esophagectomy operations do you perform personally each year?
  3. What are your overall rates of complications?
  1. what would you estimate my risk of complications
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